Antihypertensive effects of a new transdermal delivery system for clonidine (M-5041T) in spontaneously hypertensive rats

The antihypertensive effects of a new transdermal delivery system for clonidine (clonidine tape; M-5041T) were investigated in spontaneously hypertensive rats and normotensive Wistar-Kyoto rats. In spontaneously hypertensive rats, M-5041T, at doses of 0.5-4.5 mg/kg (1.25-11.25 cm2/kg), produced a dose-dependent decrease of both systolic blood pressure and heart rate for 24 hr during transdermal application. These significant hypotensive effects lasted for 24 hr following the patching of M-5041T on the back of the animals at a dose of 4.5 mg/kg. In normotensive Wistar-Kyoto rats, the hypotensive and bradycardic effects of M-5041T were weak compared with those in spontaneously hypertensive rats. In both rat strains, M-5041T (4.5 mg/kg) caused behavioral changes such as sedation, piloerection and exophthalmos, accompanied by hypotensive effects. Both M-5041T (1.5 mg/kg) and clonidine (50 micrograms/kg, subcutaneously and 100 micrograms/kg, orally) induced similar hypotensive effects, accompanied by sedation. The hypotensive effects following transdermal M-5041T or systemic clonidine administrations were correlated with the time courses of the plasma clonidine concentration. In contrast to clonidine administered subcutaneously or orally, M-5041T produced a gradual increase in the plasma clonidine concentration, which persisted at a consistent level for at least 12 hr thereafter. Significant hypotensive effects lasted for 12 and 24 hr following M-5041T patching at 1.5 and 4.5 mg/kg, respectively. The present findings suggest that M-5041T can serve as an efficient and useful antihypertensive transdermal delivery system to achieve persistent blood pressure control.

Improvement of therapeutic effect by using Fab' fragment in the treatment of carcinoembryonic antigen-positive human solid tumors with adriamycin-entrapped immunoliposomes

To improve the therapeutic efficiency adriamycin entrapped in antibody-conjugated liposomes, Fab' fragment was used instead of the whole antibody molecule. The murine monoclonal antibody, 21B2, against human carcinoembryonic antigen (CEA) was digested with pepsin, and the thiol residue of intra-heavy chain produced by reduction of F(ab')2 with dithiothreitol was conjugated to liposomes containing adriamycin. The tissue distribution of adriamycin delivered with these liposomes was studied in BALB/c nu/nu female mice bearing CEA-positive human gastric cancer strain MKN-45. An increase in delivery of adriamycin to the tumor was observed in the mice given liposomes with Fab' fragment as compared to those given liposomes with whole antibody. However, the preferential distribution of adriamycin in liposomes to the reticuloendothelial cells remained the same regardless of the use of Fab' fragment. For investigation of in vivo therapeutic effect, three i.v. injections of free adriamycin or adriamycin in liposomes equivalent to 5 mg/kg were given, and adriamycin in Fab' fragment-conjugated liposomes was found most effective in the inhibition of tumor growth. This was confirmed in terms of actual tumor weights excised and CEA concentration in the blood, as well as by pathological observations. The advantages of using Fab' fragment instead of whole antibody are discussed.

Vasodilatory effect of arginine vasopressin is mediated by nitric oxide in human forearm vessels

Arginine vasopressin (AVP) causes biphasic changes in vascular resistance in human forearms; vasoconstriction at lower doses and vasodilation at higher doses. Vasoconstriction is mediated by the V1 receptor. However, the mechanism of AVP-induced vasodilation is not known. We investigated whether AVP-induced vasodilation is mediated by nitric oxide (NO) in human forearms by examining the effects of L-arginine (a precursor of NO) and NG-monomethyl-L-arginine (L-NMMA, a blocker of NO synthase) on AVP-induced vasodilation. AVP was infused intraarterially at doses of 0.05, 0.1, 0.2, 0.5, and 1.0 ng/kg per min (n = 8). The lower doses of AVP (< or = 0.1 ng/kg per min) increased, whereas the higher doses of AVP (> or = 0.5 ng/kg per min) decreased forearm vascular resistance (FVR) (P < 0.01). Intraarterially infused L-arginine at 10 mg/min did not alter arterial pressure, baseline FVR, or heart rate. L-arginine did not alter the magnitude of AVP-induced vasoconstriction at the lower doses, but L-arginine augmented the magnitude of AVP-induced vasodilation at doses of 0.2 (P < 0.05), 0.5 (P < 0.01), and 1.0 (P < 0.05) ng/kg per min. In another group (n = 6), intraarterially infused L-NMMA (4 mumol/min for 5 min) increased baseline FVR without systemic effects, and inhibited acetylcholine-induced vasodilation (P < 0.01). L-NMMA at this dose inhibited AVP-induced vasodilation (P < 0.01) but did not affect vasoconstriction. L-arginine reversed the inhibitory effect of L-NMMA. Our results suggest that the vasodilatory effect of AVP may be mediated by NO in human forearms.

Inflammatory pseudotumor in the submandibular region. Clinicopathologic study and review of the literature

A rare case of right submandibular inflammatory pseudotumor in a 63-year-old man is reported. The tumor appeared as a symptomless swelling in the submandibular region and resembled a malignant neoplasm on computed tomographic and magnetic resonance images. Surgical resection was required. The pertinent English and Japanese literature is reviewed, and histologic and electron microscopic findings are discussed.

Bilateral coronoid process hyperplasia and short stature. A case report

A 23-year-old man with bilateral coronoid process hyperplasia and short stature is presented. These findings are characteristic features of trismus-pseudocampylodactyly syndrome. However, in this patient the pseudocampylodactyly component and family history were absent.

Inhibition of nitric oxide formation in the nucleus tractus solitarius increases renal sympathetic nerve activity in rabbits

It has been shown that nitric oxide (NO) is synthesized in the central nervous system as well as in vascular endothelial cells. However, the physiological role of NO in cardiovascular regulation by the central nervous system remains unclear. This objective of this study was to examine the possibility that NO plays a role in neural transmission in the nucleus tractus solitarius (NTS) and thus contributes to control of sympathetic nerve activity in rabbits. We examined the effects of NG-monomethyl-L-arginine (L-NMMA), an inhibitor of the formation of NO from L-arginine, microinjected into the NTS on arterial pressure (AP), heart rate (HR), and renal sympathetic nerve activity (RSNA). L-NMMA increased AP and RSNA in rabbits with intact as well as denervated sinoaortic baroreceptors and vagi. L-NMMA increased HR only in rabbits with sinoaortic denervation and vagotomy. Pretreatment with L-arginine microinjected into the NTS, which did not alter baseline AP, HR, and RSNA, prevented the increases in AP and RSNA evoked with subsequent L-NMMA. Pretreatment with D-arginine did not alter the effects of subsequent L-NMMA injections into the NTS. The gain of arterial baroreflex control of RSNA assessed by the slope of the regression line relating changes in AP and those in RSNA caused by intravenous phenylephrine or nitroglycerin did not differ before and after microinjections of L-NMMA. L-NMMA microinjected into the area postrema did not alter AP, HR, or RSNA. These results suggest that in rabbits NO is involved in the mechanism in the NTS that mediates tonic inhibition of RSNA.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparison of typical and atypical bronchoplasty for bronchogenic carcinoma]

One-hundred and twenty-eight patients who underwent bronchoplasty for bronchogenic carcinoma from 1969 to 1990 were retrospectively analyzed. Ninety-six patients had upper sleeve lobectomy or upper lobectomy with wedge bronchoplasty (typical procedure) and 32 underwent bronchoplasty with lobectomy other than upper lobes (atypical bronchoplasty). The two groups were statistically similar in preoperative characteristics including sex, age, cell types and stages. In typical group, right upper sleeve lobectomy was performed in 48 patients, left upper sleeve lobectomy in 27, right upper lobectomy with wedge bronchoplasty in 11, left upper lobectomy with wedge bronchoplasty in 7 and sleeve bronchoplasty alone in 2. In atypical group, right middle and lower lobectomy with sleeve bronchoplasty in 10 patients, left lower sleeve lobectomy in 5, right lower lobectomy with wedge bronchoplasty in 4 and others in 13. Postoperative mortality was 5.2% in the typical group and 9.4% in the atypical group. Postoperative respiratory complications occurred in 16 patients (50%) in the patients with the atypical group and in 33 (34.7%) in those with typical group. Three years and 5 years survival rates in the typical group were 46 and 40% and those in the atypical group, 27 and 18%. However, there was no statistical difference in survival between the two groups. In conclusion, atypical bronchoplasty is useful for preserving the lung parenchyma, but, careful perioperative management and surgical technique of bronchoplasty are mandatory.

Decreased blood coagulation activities in carbohydrate-deficient glycoprotein syndrome

The carbohydrate-deficient glycoprotein (CDG) syndromes are a newly recognized group of inherited metabolic diseases. We report a Japanese brother and sister with a CDG syndrome. Both patients showed decreased activities of blood coagulation Factor XI and of the coagulation inhibitor protein C. In one of them there was also a somewhat decreased activity of Factor IX and of antithrombin III. Isoelectric focusing of antithrombin III revealed a decrease of negatively charged fractions and an increase of more cathodal bands. Furthermore, there was a discrepancy between activity and antigen level of Factor VIII and protein C. The patients had an incidental deficiency of factor XII. This is the first detailed report on blood coagulation systems in the CDG syndromes. These blood coagulation abnormalities may explain at least in part the thrombotic or haemorrhagic complications of the CDG syndromes.

Methylglyoxal bis(butylamidinohydrazone) exhibits antitumor effect on human malignant melanoma cells but reduces the antitumor action of cisplatin

The antitumor effect of a polyamine biosynthetic pathway inhibitor methylglyloxal bis(butylamidinohydrazone) (MGBB) on human malignant melanoma (HMG) cells and its combination effect with cisplatin were investigated. The growth of cultured HMG cells was inhibited in a dose dependent manner by either MGBB or cisplatin; complete inhibition of cell proliferation was attained with 5 micrograms/ml of MGBB or 50 micrograms/ml of cisplatin. Pretreatment of HMG cells with MGBB diminished the antitumor action of cisplatin. The cultured HMG cells were inoculated in nude mice and aliquots of the resulting solid tumors (HMG tumor) were transplanted. The growth of transplanted HMG tumors in mice was inhibited markedly by cisplatin (3.8 mg/kg) and moderately by MGBB (10 or 20 mg/kg). The in vivo antitumor effect of cisplatin was also reduced by combined treatment with MGBB.

Effects of L-arginine on forearm vessels and responses to acetylcholine

This study was designed to investigate the effects of L-arginine (the substrate of endothelium-derived nitric oxide) in human forearm vessels. We examined whether intra-arterial infusion of L-arginine dilated forearm vessels and augmented vasodilatory responses to acetylcholine in young, healthy humans. The left brachial artery was cannulated for drug infusions and direct measurement of arterial pressure. Forearm blood flow was measured by a strain gauge plethysmograph. Intra-arterial infusions of L-arginine at 10, 20, 40, and 60 mg/min increased forearm blood flow from 4.7 +/- 0.6 to 4.9 +/- 0.5, 5.7 +/- 0.5, 7.2 +/- 0.8, and 8.2 +/- 0.9 ml.min-1.100 ml-1, respectively (n = 8, p less than 0.01), whereas D-arginine at the same doses did not alter forearm blood flow (n = 7). Intra-arterial infusions of acetylcholine (n = 7) (4, 8, 16, and 24 micrograms/min) and sodium nitroprusside (n = 5) (0.2, 0.4, 0.8, and 1.2 micrograms/min) increased forearm blood flow dose dependently (p less than 0.01 for both). Arterial pressure was not altered with infusions of these drugs. Responses to acetylcholine were augmented with simultaneous intra-arterial infusion of L-arginine at 10 mg/ml (p less than 0.01) but not with D-arginine. Responses to sodium nitroprusside were not altered by L-arginine. These results in human forearm resistance vessels support the notion that vasodilation induced by acetylcholine is a result of the conversion from L-arginine to endothelium-derived nitric oxide.(ABSTRACT TRUNCATED AT 250 WORDS)

Primitive reflex profiles in infants: differences based on categories of neurological abnormality

In order to clarify reflex profiles in the first year of life in connection with categories of neurological abnormality, six primitive reflexes, i.e., the crossed extensor reflex, suprapubic extensor reflex, heel reflex, Galant response, asymmetric tonic neck reflex and plantar grasp response, were examined in 458 normal infants, 78 infants with cerebral palsy (CP) and 81 infants with mental retardation (MR), whose diagnoses were confirmed at a later follow-up examination. The change in the mean score for each of these reflexes with age was characteristic for each category or type of neurological abnormality. This implies that a presumptive diagnosis can be made in neurologically high-risk infants by examination of the primitive reflexes. Such reflexes are therefore of specific significance, among other neurological criteria, in infants within the first year of life.

[Perinatal neurosurgical care for one fetal hydrocephalus on twin gestation]

Twin gestations are responsible for a disproportionate amount of perinatal mortality and morbidity. Such gestations may impose greater demands on maternal and child physiologic systems than singleton pregnancies. The most common antenatal complications were preterm labor. The clinical record of myelomeningocele infant presenting with overt hydrocephalus in utero at 27 weeks of twin gestation and operated miniature Ommaya's reservoir placement early after birth and intentional delayed back closure for myelomeningocele was reported. Although perinatal neurosurgical care for one fetal hydrocephalus on twin gestation is clearly advantageous, it alone is relatively ineffective in reducing the incidence of the complication, preterm labor.

Comparison of bone matrix-derived bone morphogenetic proteins from various animals

Bone matrix-derived bone morphogenetic protein (BMP) was extracted from bovine, porcine, rabbit, Sprague-Dawley rat, and Wistar rat bone and purified. The purified fractions all had similar molecular weights and induced new bone in 3 weeks when implanted into muscle pouches of Wistar rats. Bone matrix-derived BMP is believed to consist of subunits and that of different animal origin to contain the same fraction with BMP activity.

Internal carotid arterial blood flow velocity in infants

The differences in the velocity and pulsatility indexes in the internal carotid artery were evaluated in 62 normal controls, 42 infants with cerebral palsy, and 22 infants with mental retardation, all within the first year of life. In the normal controls, the average maximal blood flow velocity (A/L), and the maximal end-diastolic flow velocity increased during the first year of life. Pulsatility index decreased significantly between the ages of newborn to 2 mos and 3-5 mos, and remained constant thereafter. Compared with normal controls, the average maximal blood flow velocity and the maximal end-diastolic flow velocity values were significantly reduced in infants with cerebral palsy during the first 6 months of life, while no differences in these values were observed in infants with mental retardation. There were no differences in the pulsatility index values in the 3 subject groups throughout the first year of life. Flow velocity in the internal carotid artery could reflect the status of the cerebral circulation in infants within the first year of life.

Endothelium-dependent forearm vasodilation to acetylcholine but not to substance P is impaired in patients with heart failure

It has been shown that endothelium-dependent vasorelaxation in response to muscarinic stimulation is attenuated in patients as well as animals with heart failure. This study aimed to determine if endothelium-dependent forearm vasodilation evoked with substance P (SP) as well as acetylcholine (ACh) was impaired in patients with heart failure. Forearm blood flow was measured using a strain-gauge plethysmograph and forearm vascular responses to intra-arterial infusions of ACh, SP, or sodium nitroprusside (SNP) at graded doses were examined. The drugs caused the dose-dependent increases in forearm blood flow (FBF) and the decreases in forearm vascular resistance (FVR) in patients with heart failure as well as normal subjects. However, the percent decreases in FVR by ACh were less in patients with heart failure than in normal subjects (p < 0.01). In contrast, the percent decreases in FVR by SP or SNP did not differ between the two groups. These results suggest that endothelium-dependent vasodilation of forearm resistance vessels via muscarinic receptors is specifically impaired, whereas via SP receptors, is preserved in patients with heart failure.

Analysis of bone morphogenetic protein (BMP) derived from human and bovine bone matrix

Recently, Bone Morphogenetic Protein (BMP) has attracted the attention of a number of investigators, but its elucidation remains incomplete. At present, the determination of its amino acid sequence, which is necessary for its synthesis, and screening for a carrier that allows BMP to be effective in small amounts are unsolved problems. Bone morphogenetic protein is studied here to clarify its clinical applications. BMP was extracted from human and bovine bone matrix with 4 M guanidine-HCl and purified by liquid chromatography. Acrylamide electrophoresis (SDS-PAGE) and isoelectric focusing (IEF) showed that the purified BMP was homogeneous. We used type I collagen as the carrier in the bioassay. This BMP induced new bone in situ three weeks after implantation in muscle pouches in Wistar rats. The molecular weights of human and bovine bone matrix-derived BMP are 17.0 and 18.0 kDa by SDS-PAGE, and pI values for both are 4.9 by IEF. Human and bovine bone matrix-derived BMP are peptides containing 165 and 163 amino acids, respectively, according to amino acid analysis. The NH2-terminal sequence of bovine bone matrix-derived BMP was obtained from the bovine band, electroblotted onto polyvinylidene difluoride membrane, that corresponded to the final purified fraction. The sequence differs from previously designated BMPs25 and other proteins reported to have similar activity, but the physicochemical characteristics are comparable to the native preparations.

Induced microseizures in West syndrome

Induced microseizures (IMS) were observed in a 5-month-old girl with symptomatic West syndrome. The seizures occurred following the suppression of infantile spasms with adrenocorticotropic hormone therapy and disappeared following the cessation of clonazepam administration. The ictal manifestations consisted of periods of irregular respiration, and respiratory arrest lasting for several seconds which often involved opening of the eyes and mild extension of the neck corresponding with the diffuse fast wave bursts in EEG activity observed during sleep. These seizures were thought to be equivalent to the IMS in Lennox-Gastaut syndrome, which have never been reported before in patients with West syndrome.

[Catecholamine fluorescent, acetylcholinesterase positive and peptide immunoreactive nerve fibers in the rat hepatic portal system]

Innervation of rat hepatic portal system consisting of stem (portal vein) and peripheral portions (superior mesenteric vein, inferior mesenteric vein, splenogastric vein) was investigated by catecholamine fluorescence, acetylcholinesterase and immunohistochemical methods. Catecholamine fluorescent and Neuropeptide Y (NPY) immunoreactive (ir) nerve fibers were distributed throughout the hepatic portal system. Greater density was demonstrated in the peripheral portions. Catecholamine fluorescent and NPY ir nerve fibers formed ground plexus around the hepatic portal system. Acetylcholinesterase positive and vasoactive intestinal polypeptide-ir nerve fibers were sparsely distributed and no significant difference in density was noticed in the stem and the peripheral portions. Density of substance P ir, neurokinin A ir and calcitonin gene-related peptide ir nerve fibers was greater in the peripheral than the stem portion. All these fibers reticular showed pattern.

Human dentin-matrix-derived bone morphogenetic protein

Bone morphogenetic protein (BMP) was extracted from human dentin matrix with 4 mol/L guanidine-HCl and was purified by liquid chromatography. SDS-PAGE and IEF showed that the purified BMP was homogeneous and induced new bone formation in situ after three weeks when implanted into muscle pouches in Wistar rats. The molecular weight of BMP was estimated to be about 20.0 kDa by SDS-PAGE, and the pI value was 8.8 by IEF. Amino acid analysis suggested that BMP is a protein containing 191 amino acids. A partial amino acid sequence was obtained from the final purified BMP. Dentin-matrix-derived BMP is probably not identical to, but is similar to, bone-matrix-derived BMP, though both types of BMP have the same action in vivo.

The vascular architecture and innervation of the cerebral arteries in Leiothrix lutea

The vascular architecture and innervation of the cerebral arteries in the robin-billed leiothrix, Leiothrix lutea, were studied using catecholamine fluorescence, acetylcholinesterase active staining, and immunohistochemical techniques. The cerebral arteries in Leiothrix lutea consisted of the cerebral carotid and the basilar systems. The cerebral carotid artery can be divided into the anterior and posterior rami. Due to poor development of the posterior ramus, the posterior cerebral artery originated from the anterior ramus, and an anterior communicating artery between the cerebroethmoidal arteries formed the circle of Willis. The cerebral carotid system was supplied with aminergic nerve fibers (Amn), cholinergic nerve fibers (Chn) and peptides [substance P (SP), neurokinin A (NKA), calcitonin gene related peptide (CGRP) and vasoactive intestinal polypeptide (VIP)]-like immunoreactive (LI) nerve fibers in all regions. These nerve fibers were abundant in the cerebral carotid system, but were few and scattered in the basilar system. Only neuropeptide Y (NPY)-LI nerve fibers were recognized in moderate numbers in the cerebral carotid system, but were not found in the basilar system. Innervation of the small blood vessels of the cerebral parenchyma differed from that of the cerebral superficial arteries, SP-, NKA-, CGRP- and VIP-LI nerve fibers showed a dense distribution, but Amn and NPY-LI nerve fibers showed a sparse distribution, and almost no Chn was observed. Double staining in the cerebral arteries for SP-, NKA- and CGRP-LI nerve fibers demonstrated exactly the same distribution. This suggests that SP, NKA and CGRP co-exist in the same fiber.(ABSTRACT TRUNCATED AT 250 WORDS)

Interaction of zonisamide with benzodiazepine and GABA receptors in rat brain

The effects of zonisamide on [3H]flunitrazepam binding and [3H]muscimol binding were studied in Sprague-Dawley rat brain. Specific [3H]flunitrazepam bound was decreased to 64.6 +/- 5.6% (mean +/- SD, n = 5, p < 0.002) and 91.9 +/- 4.0% (p < 0.005) by the addition of 10(-3) M and 10(-4) M zonisamide, respectively. Scatchard plot analysis of [3H]flunitrazepam binding with 10(-3) M of zonisamide revealed an increased Kd value with no change in Bmax. No inhibitory effect of zonisamide was seen on the enhancement of specific [3H]flunitrazepam binding by GABA. As for the effects on GABA receptors, specific [3H]muscimol bound was decreased to 27.7 +/- 10.4% (mean +/- SD, n = 4, p < 0.005) and 68.3 +/- 3.7% (mean +/- SD, n = 4, p < 0.005) by the addition of 10(-3) M and 10(-4) M zonisamide, respectively. Since therapeutic serum level of zonisamide are around 10(-4) M, these results suggest that zonisamide neuropharmacologically interacts with the GABA/benzodiazepine receptor ionophore complex in a manner similar to phenytoin.

[3H]zonisamide binding in rat brain

We previously reported that zonisamide inhibits both [3H]flunitrazepam and [3H]muscimol binding in rat brain. In the present study, [3H]zonisamide was found to bind in a saturable fashion to the crude synaptosomal fraction of whole rat brain. Linear regression analysis of the binding data in the Scatchard plot indicated a Kd of 90 nM, and a maximal binding capacity of 1.40 x 10(3) fmol/mg protein. Displacement studies revealed an inhibitory effect of clonazepam and an enhancement effect of GABA on specific [3H]zonisamide binding. These results suggest that specific [3H]zonisamide binding sites may have a tight correlationship with benzodiazepine receptors in rat brain.

Purification of rabbit bone morphogenetic protein derived from bone, dentin, and wound tissue after tooth extraction

Bone morphogenetic protein (BMP) was extracted from bone matrix, dentin matrix, and wound tissue after tooth extraction in rabbits, and purified. These purified fractions were shown to be homogeneous by sodium dodecyl sulfate-polyacrylamide slab gel electrophoresis (SDS-PAGE), and induced new bone in situ in 3 weeks when implanted into the calf muscles of Wistar rats. The dentin matrix-derived BMP was different from the other two types in molecular weight and the properties revealed in the process of purification. However, each tissue-derived BMP was shown to induce new bone growth in a bioassay of xenogenic implantation. For this reason, BMP is thought to have subunits with certain commonalities in different tissue.

Purification of bone morphogenetic protein derived from bovine bone matrix

Bone morphogenetic protein (BMP) was extracted from the bovine bone matrix and purified by liquid chromatography. The molecular weight of the BMP was 18 kDa by SDS-PAGE, and its pI value was 4.9. Amino acid analysis suggested that the BMP is a polypeptide containing 163 amino acids. In the present study, telopeptide-free type I collagen was used as a carrier of BMP.

Monostotic fibrous dysplasia with involvement of the mandibular canal

A 72-year-old woman sought treatment with a rare monostotic fibrous dysplasia occurring in the mandible and involving the mandibular canal. Her chief complaint was swelling, which had appeared about 2 years previously, had enlarged gradually, and was associated with spontaneous pain. X-ray film examination revealed a ground-glass opaque image of blurred demarcation, and 99mTc-methylene diphosphonate bone scintigraphy disclosed an area of marked radioisotope uptake. Histopathologic examination revealed the area of bone marrow and spongy bone to be replaced by fibrous tissue, irregular beam-shaped woven bone, and lamellar bone. Contouring of the expanded portion of the bone and surgical decompression of the mandibular canal were performed with good results.

Aggressive infantile fibromatosis of the submandibular region

Aggressive infantile fibromatosis is an unusual, tumor-like, proliferative lesion which grows infiltratively. The clinical and histological features of aggressive infantile fibromatosis in the submandibular region of a 3-year-old girl are reported.

EEG and CT abnormalities in xeroderma pigmentosum

Xeroderma pigmentosum associated with neurological abnormalities is a less familiar neurocutaneous disorder. In this report, 35 patients with group A xeroderma pigmentosum were assessed for neurological complications. Of these, 17 showed microcephaly and 24 mental retardation. Of 25 patients over 7 years of age, 22 had sensorineural deafness and 12 showed spinocerebellar signs such as nystagmus, dysarthria, tremor and ataxia, while none below 7 years of age had such neurological complications. Thirty-five EEG studies were performed on 29 patients, and 15 showed intermittent spindles of grouped theta waves with abnormal slow background activity and a poorly developed alpha rhythm, suggesting immature brain development or a regression from normal brain function in many areas including the diencephalon. Twenty-six patients were examined by cranial CT scan, of whom 20 showed abnormal CT findings such as ventricular dilatation, diffuse cortical atrophy, and marked thickening of the calvarial bones. The incidence of abnormal EEG and CT findings increased with advancing age in accordance with the development of neurological complications in the CNS, thus suggesting a chronic progressive degenerative disease.

[Ultrasonic Doppler assessment of hemodynamics in extra-intracranial arterial anastomosis in children with Moyamoya disease]

Recently the extra-intracranial (EC/IC) arterial bypass operation has been introduced in the treatment of Moyamoya disease and excellent postoperative outcomes have been reported. To assess the cerebral hemodynamic changes after the bypass surgery, ultrasonic Doppler flowmetry was performed in 10 children with Moyamoya disease. Their surgical treatments included superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis or encephalo-duro-arterio-synangiosis. The flow velocity and pattern of the major cerebral arteries and STAs, the donor artery of the bypass, were studied both before and after the operation. The results of Doppler flowmetry were compared with clinical symptoms and angiographical findings. Though the Doppler sonography of the major cerebral arteries showed little change, the flow velocity of the STAs revealed a pronounced and rapid increase after the bypass surgery. The flow pattern of the STAs, which was of the external carotid type preoperatively, changed to the internal carotid type postoperatively. These ultrasonic Doppler findings were thought to be due to a decrease in the peripheral vascular resistance, and suggested a good patency of the bypass arteries. These results of the Doppler flowmetry were in good agreement with clinical and EEG improvement and the findings of the postoperative cerebral angiography. It is suggested that ultrasonic Doppler flowmetry is a noninvasive and reliable method of assessing the function of the EC/IC bypass in children with Moyamoya disease.

Dandy-Walker cyst associated with occipital meningocele

Dandy-Walker cyst associated with occipital meningocele is very rare. Only 12 patients have been reported. We report a female infant with Dandy-Walker cyst and occipital meningocele whose diagnosis was suspected antenatally by in utero ultrasonography. At birth, head circumference was normal for 37 weeks gestation. She underwent surgical repair of the occipital meningocele immediately after birth. The post-operative course was uneventful until the sixth day of life when progressive enlargement of the head with progressive ventricular dilatation was recognized. Communication between the posterior fossa cyst and the occipital meningocele was confirmed neuroradiologically; the occipital meningocele may have compensated for the increased intracranial pressure in fetal life.

Aicardi syndrome associated with an embryonal carcinoma

A Japanese girl is reported who had the typical clinical features of Aicardi syndrome associated with embryonal carcinoma. She developed infantile spasms at approximately 4 weeks of age; her seizures were intractable in spite of treatment with numerous antiepileptic drugs and ACTH. At 22 months of age, her left cheek gradually became swollen. Laboratory findings were normal except for a marked increase in serum alpha-fetoprotein. A transoral biopsy of the tumor revealed an embryonal carcinoma. This patient is the first reported with Aicardi syndrome and embryonal carcinoma. The relationship between congenital malformations and neoplasms is discussed.

Innervation of the C cells of chicken ultimobranchial glands studied by immunohistochemistry, fluorescence microscopy, and electron microscopy

Innervation of the ultimobranchial glands in the chicken was investigated by immunohistochemistry, fluorescence microscopy and electron microscopy. The nerve fibers distributed in ultimobranchial glands were clearly visualized by immunoperoxidase staining with antiserum to neurofilament triplet proteins (200K-, 150K- and 68K-dalton) extracted from chicken peripheral nerves. The ultimobranchial glands received numerous nerve fibers originating from both the recurrent laryngeal nerves and direct vagal branches. The left and right sides of the ultimobranchial region were asymmetrical. The left ultimobranchial gland had intimate contact with the vagus nerve trunk, especially with the distal vagal ganglion, but was somewhat separated from the recurrent nerve. The right gland touched the recurrent nerve, the medial edge being frequently penetrated by the nerve, but the gland was separated from the vagal trunk. The left gland was innervated mainly by the branches from the distal vagal ganglion, whereas the right gland received mostly the branches from the recurrent nerve. The carotid body was located cranially near to the ultimobranchial gland. Large nerve bundles in the ultimobranchial gland ran toward and entered into the carotid body. By fluorescence microscopy, nerve fibers in ultimobranchial glands were observed associated with blood vessels. Only a few fluorescent nerve fibers were present in close proximity to C cell groups; the C cells of ultimobranchial glands may receive very few adrenergic sympathetic fibers. By electron microscopy, numerous axons ensheathed with Schwann cell cytoplasm were in close contact with the surfaces of C cells. In addition, naked axons regarded as axon terminals or "en passant" synapses came into direct contact with C cells. The morphology of these axon terminals and synaptic endings suggest that ultimobranchial C cells of chickens are supplied mainly with cholinergic efferent type fibers. In the region where large nerve bundles and complex ramifications of nerve fibers were present, Schwann cell perikarya investing the axons were closely juxtaposed with C cells; long cytoplasmic processes of Schwann cells encompassed large portions of the cell surface. All of these features suggest that C-cell activity, i.e., secretion of hormones and catecholamines, may be regulated by nerve stimuli.

Chiari I malformation with quadriplegia and respiratory disturbance in an infant

Chiari I malformation consists of variable downward displacement of the cerebellar tonsils. Quadriplegia, respiratory disturbance and pain are common in Chiari I malformation in adults. However, there are no reports of this syndrome in early childhood. We report the case of a 9-month-old girl with Chiari I malformation who had quadriplegia with muscle weakness and who developed respiratory disturbance as an early symptom. The causes of the symptoms of Chiari I malformation are discussed. The use of MRI is proposed as a more useful diagnostic technique than myelography for these patients since MRI is less likely to aggravate the respiratory disturbance.

Xeroderma pigmentosum with versive seizures

A boy with group A xeroderma pigmentosum and a series of progressive neurologic complications developed versive seizures at 8 years of age. Electroencephalography at 6 years of age revealed no epileptic changes or focal abnormalities. He was seizure-free until versive seizures developed; electroencephalography revealed frequent spike discharges in the right central and temporal regions. Neurologic complications and electroencephalographic abnormalities of 34 patients with group A xeroderma pigmentosum also were assessed. Only 3 patients with xeroderma pigmentosum have been reported to have a seizure disorder. This patient is the fourth reported with group A xeroderma pigmentosum associated with a convulsive disorder. Although neurologic manifestations in group A xeroderma pigmentosum are progressive and severe, it is unknown why so few of these patients develop seizure disorders.